Correlation of Cigarette-Induced Increase in Serum Nicotine Levels with Arginine Vasopressin Concentrations in the Syndrome of Self-Induced Water Intoxication and Psychosis (SIWIP)

Ten patients [9 men and 1 woman; mean age 42.4 ± 8.5 (± SD) years] who were smokers and who suffered the complications of self-induced water intoxication and psychosis (SIWIP) (8 patients with schizophrenic disorders, 1 patient with manic-depressive illness, 1 patient with dementia) are reported. Each patient underwent serial determinations of parameters of water metabolism including plasma and urine osmolality and plasma arginine vasopressin (AVP). The syndrome of inappropriate antidiuresis (SIAD) was found in each patient. Because of the reported effect that cigarette smoking has on anti-diuresis, we correlated serum nicotine (NIC) levels with plasma and urine osmolality, AVP, and 24-hour urine volume (24°-UV). We found no relationship between NIC and plasma or urine osmolality, AVP, or 24°-UV. In the presence of SIWIP and SIAD, we infer the limbic-hypothalamic neurotransmitters in these psychotic patients are sufficiently powerful in stimulating both compulsive water drinking and inappropriate release of AVP so as to overshadow any effects that NIC may have on water metabolism.